Provider Demographics
NPI:1306941703
Name:BURKE, WILLIAM ROMNEY (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROMNEY
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 DIVISION ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045
Mailing Address - Country:US
Mailing Address - Phone:503-656-2606
Mailing Address - Fax:503-656-7546
Practice Address - Street 1:1510 DIVISION ST
Practice Address - Street 2:SUITE 10
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045
Practice Address - Country:US
Practice Address - Phone:503-656-2606
Practice Address - Fax:503-656-7546
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORM011108208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218347Medicaid
C92324Medicare UPIN
103726Medicare ID - Type Unspecified